Provider Demographics
NPI:1720284912
Name:WRIGHT, VIVIAN LYNNE
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:LYNNE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 GRIFFEY WAY
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3065
Mailing Address - Country:US
Mailing Address - Phone:209-744-9909
Mailing Address - Fax:
Practice Address - Street 1:12370 CLAY STATION RD
Practice Address - Street 2:
Practice Address - City:HERALD
Practice Address - State:CA
Practice Address - Zip Code:95638-9757
Practice Address - Country:US
Practice Address - Phone:209-744-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator